Explaining UltraGenda with two different methods

This section elaborates on the preferences of the participants of one of the methods over the other: explaining the software UltraGenda, without or with the use of Essomenic. All the participants unanimously preferred the explanation with the use of Essomenic. The participants indicated that they had a better understanding of the software after the explanation with Essomenic. In this section, I evidence the reasons for their preference for using patient journey modelling, such as Essomenic, which included: easier to convince the need for change, explanation of the why, and that it is a visual and stepwise approach. Further I explain why it could be useful as education technique, the understanding of the why and how it can improve the communication between stakeholders.

5.2.1

Visualisation of new working process

In order to fulfil the process in its entirety, one must complete steps in the correct order. It is important to understand each step and how it works within the process before moving onto the next step. When staff understand each step and its purpose, this will decrease the number of mistakes, allowing the healthcare process to improve its efficiency. The following quotes provide evidence for this:

“I am visual. So I like the flowchart aspect and I what I really liked was that I can have a full understanding of the patient's journey. The other one [explaining software with PowerPoint] I didn't understand; it was just a process. You were teaching me how to do something to get a patient appointment but I had no background or understanding of why I was doing all of those things or I would be doing all of those things.” (Participant 6)

“Because I see exactly what’s going and have a look at the other screen so I’m actually get a better idea chapter by chapter and seeing the process from top to bottom and not having so many questions in the back of my head.” (Participant 2) “It is very simple to see, you know who [staff and patient] is going to be involved, if there is a document generated, what actually has to happen. So I like the idea of that. It looks very straight forward to me.” (Participant 3)

Using a visualisation technique will assist staff in a better and quicker understanding of the technology and change. Explaining the software by visualising the process steps, will support with a quicker uptake. Without visualisation, staff are less likely to use the software by themselves. It is much harder reading a manual rather than have a visual of the process and see how the software or technology works. The latter, explanation with use of Essomenic, was clearly preferred by all the

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participants and required less ongoing support from the software company. One of the interviewees argued:

“Just because, for the first one could I do it again if you left me alone? … I actually couldn't do it again. I would need you still to be here. With the second explanation I think I would have a resource where I could possibly do it again.” (Participant 6)

This quote indicates that visualisation may assist with changing behaviour as it links ‘the how’ and ‘the why’. As discussed in the literature chapter, a theory driven implementation framework has a higher chance of being successful when direct links are established between the intervention and behaviour change (Lapointe & Rivard, 2005; Piderit, 2000). Visualisation will achieve this. Thus, the participants could see a real benefit using Essomenic for the implementation of UltraGenda software.

5.2.2

Showing relationships between healthcare workers, patients and technology.

Essomenic shows additional dimensions that other modelling approaches ignore. These include patient needs, evidence-based clinical practice and complex multiple-path process flows. In addition, Essomenic is highly graphical and visual, making it easy for both clinical and non-clinical staff to understand. Essomenic shows the interactions with staff and technologies, during the patient’s healthcare pathway. Essomenic helps people to understand their systems in such what that changes are easily implemented (Curry, 2008). In addition, in Essomenic, step by step is mapped out on how to use the new software is and clearly displays who is involved with a particular process step, and how this affects the patient. Showing these relationships is essential to understand the entire process. One respondents commented:

“I find that relationship of the steps in their relevant screen is much better to portray the information.” (Participant 7)

Another had a much better understanding of the sequence of events resulting in a desired outcome when using Essomenic. She stated:

“You need to know why you have to change your practice and you need to know why you’re doing it. Somebody just come along and say do this now and not give you a reason why because then you’ll going to get revolve in the system. So, people need to know why you’re doing it, why the changes happening and the outcomes are a bit outcomes for the patients.” (Participant 4)

Using visualisation techniques supports with gaining a better understanding of the scheduling software as it shows a more understandable way of what the benefits of the new software

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UltraGenda are and how to use it. According to Rapert et al. (2002) a lack of clear common understanding is a major barrier in implementation process (Rapert, Velliquette, & Garretson, 2002). Essomenic provides an end-to-end view of the system of care as experienced by the patient and can assist in giving a common understanding between healthcare workers and software developers in the healthcare and implementation process. Hence, using Essomenic would be helpful to bridge this barrier.

Using visualisation techniques assists in showing where the patient, staff and technologies fits into the patient journey. The following are some comments participants made in regards to patient journey modelling:

“My assumption is that Essomenic will help people see entire picture where they fit in but more importantly where the patient fits in.” (Participant 1)

“So what I like is the way you can see where the interactions happen when you got the staff and patients together for the patient. So the patient or whoever is the user can look at it and go oh this is an opportunity to have these people either talking together or whatever.” (Participant 3)

“It actually takes the focus away of the boss wants it or the nurse wants or the company wants you to have it. It actually can tell the story why it could be more important for the patient. And that is a motivating factor for most because it de- personalizes things from what people want who are working on it; the centricity around the clinician to the centricity of the patient.” (Participant 1)

According to Curry (2008) patient journey modelling, such as Essomenic, shows the complex stakeholder interactions and clinical streams that occur within healthcare. Using PJM also results also in more comprehensive, robust and specific models that will decrease process variability and increase patient safety (Curry, 2008). In addition, models contribute in building consensus among (particularly difficult to convince medical) staff and assist in the planning of interventions and improvements (Camann, 2001). Hence, PJM, such as Essomenic, will help in giving insight in the interactions of patients, carers and technology and will put the centricity around the patient.

According to Nilsen’s (2012) theoretical categorisation of implementations, the use of technology to implement an innovation would fall under the ‘process theory’. Essomenic uses a stepwise approach that tells the patient journey. Besides, Essomenic explains the process steps in using the technology, UltraGenda. It tells the staff step by step how to use the software. Hence, using Essomenic gives a clear view on how to use UltraGenda and where it is involved in the healthcare process.

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5.2.3

Visualisation as an educational technique

As stated above, visualisation techniques are useful to educate the new software. In addition, it is also useful as an orientation technique or simply a reminder of how the software can be used to serve the patients best interest. Most participants confirmed this, evidenced by the following quotes:

“Well I think it's going to be useful for when you are teaching the admin staff to be able to use this piece of software, for them to be able to look at it to go; you know like it is very simple to see, you know who is going to be involved, is there a document generated, what actually has to happen. So I like the idea of that. It looks very straight forward to me.” (Participant 3)

“You get consistency because everyone will be shown the same way. I like that fact that where you put your little people, who is involved in which step that's really good as well.” (Participant 7)

“For me, I learn particularly and don’t usually use journey boards but I think it’s a great way and I would pick up a system a lot quicker if I had a journey board….” (Participant 2)

“.. if we had those visual pictures sort of up on the wall or whatever it gave you each step, I think the learning would’ve been quicker.” (Participant 9)

Novice learners, or new staff members, can become quickly overwhelmed by too many details or windows of a software program (Naps et al., 2002). Using PJM, such as Essomenic, to explain how a technology works, will assist in giving an easier and more understandable explanation of how a technology works.

One of the main advantages of process mapping tools for the use in cooperative learning is their adaptability to a specific content. Using pictures and certain types of relations provided in clear abstract concepts can assist with the focus the staffs’ discourse on relevant aspects without undue constraint (Fischer, Bruhn, Gräsel, & Mandl, 2002). Content specific visualisation encourages the staffs’ focus on the task-relevant content and increases the quality of the processes of collaborative knowledge construction (Fischer et al., 2002). Therefore, visualisation techniques, such as Essomenic will be useful for the initial and ongoing education of complex software.

The advantages and disadvantages of visualisation have been researched in different contexts. For example, Murre et al. (2013) surveyed 28000 participants between 11 to 80 years of age. This research investigated if human memory has preference for either verbal memory or visuospatial

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memory. This research shows that the visuospatial memory is dominant (>60%) in both the short and the long term memory of all the research participants, indicating the advantages of visualisation (Murre, Janssen, Rouw, & Meeter, 2013). Further to this research, visualisation is said to enable new perspectives, because pictures have been shown to inspire creativeness and imagination of people (Whyte, Ewenstein, Hales, & Tidd, 2008). According to Tversky (2011 the human's input channel capacity is larger when visual competences are used (Tversky, 2011). Visualisation supports solving complex problems by condensing information (Vessey, 1991). In addition, different studies have shown that visual representations are superior to verbal sequential representations in different knowledge tasks (Bauer & Johnson-Laird, 1993; Burkhard, 2004; Glenberg & Langston, 1992; Larkin & Simon, 1987). Using visual techniques is effective for the transfer of knowledge. As described in the literature chapter, visualisation techniques has many advantages, which are presenting new perspectives by discovering trends abnormalities and unexpended connections, motivate and engage people, providing a greater understanding and interpreting of complex data and situation (Cook et al., 2007; Wong et al., 2006). Because visualisation techniques have so many benefits, it would be very useful for the implementation process of a new innovation. Thus it is no real surprise, that, in this research, all participants preferred visualisation over verbal and written explanations. Hence, Essomenic as an educational technique seems most effective.

5.2.4

Visualisation techniques to aid convincingness

As the participants mentioned, staff generally do not like change. However, using visualisation technology such as Essomenic, could be a valuable technique to convince staff to adopt new practices. One respondent reflected:

“So if you go from the premise that nobody likes change then would this be more convincing? Probably. It would probably be more convincing.” (Participant 1) Another participant mentioned:

“It's easier to visualise it [change] and you can actual see the process rather than talk about it in very various words. And people learn better from visual rather than by explanation or by PowerPoint.” (Participant 8)

Another participant said:

“And so if you deliver something that shows patient centred care, and how they fit into that journey, that’s where you’ll convince people.” (Participant 9)

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Using the visualisation technique explains the reasons why and where change results in efficiency (Curry, 2008). By the way of using a story board, people can relate to the new processes, and therefore visualisation techniques will be more convincing. The next section briefly discusses the third part of the interviews which was about how visualisation would have assisted implementation of technology in the participants’ own context, as mentioned in Part 1 of the interview.